Tuesday, 3 February 2015

The allure of the new

As human beings, we are
attuned to notice the special or different. We also tend to like simple answers
to complex questions. Perhaps they make us feel more in control of the complicated
environments we find ourselves in. I wondered about this during a recent trawl
for ‘depression cures’ on news websites. Suggestions included 9-stone
weight loss, magic mushrooms
(complete with obligatory 3D brain picture to enhance credibility), laughing
gas and ketamine.
It seems that we are on the lookout for simple-sounding and miraculous cures
for our ailments. After all, the prospect that things can be fixed ever faster
and with less effort sounds great. With a bias towards the novel and apparently
miraculous, I wonder how we can appraise new, glamorous or cutting edge treatments?
Can we judge such shiny new arrivals fairly?

A recent example of such a
new treatment is Deep Brain Stimulation (DBS)
DBS seems to be helpful to people experiencing a range of
motor-related physical problems, and is most commonly used with people
experiencing Parkinson’s disease. Implantation of electronic devices to help
people to overcome physical conditions seems to make sense, and qualitative
explorations of the impact of DBS for people with primary dystonia (a
condition characterised by involuntary muscle spasms) suggest its effects can
be life-transforming. But, there is a danger here
that may come from the magnetic attraction of the shiny and new. In particular I
was somewhat concerned to learn of possible mission
creep for DBS. If it’s good for the difficulties above might it also help
with other problems? DBS is currently being piloted for use with people
experiencing emotional distress. This results from mood-related side-effects
that were reported by people being treated for physical conditions with DBS. People
diagnosed with depression and people diagnosed with Obsessive
Compulsive Disorder (OCD) have been part of pilot trials to see whether DBS
can help them. Some of the language used in the reporting of these trials seems,
at the very least, detached from the human experience of depression:

‘DBS
to different sites allows interfering with dysfunctional network function
implicated in major depression’. (Link).

Such explanations for an
effect of DBS seem to locate the problems people are experiencing very
much within them, implying that their difficulties are due only to faulty
connections, rather than being related to ways that they are trying to
navigate difficulties that they are experiencing or have experienced in the
past. Viewing a treatment in this way takes agency away from the person, and
might make changes they experience seem artificial, or divorced from their
realities. If they feel better when their stimulator battery is topped up, or
settings are modified, then is that something they can feel ownership of? Do
they decide their settings, or does a professional set them, potentially
implying expert-knowledge of what might be the best emotional state for
them?

Who decides what the
correct state of mind someone should experience is? What if people felt better
when nothing had apparently been changed in relation to the DBS implants: is it
a result of their efforts, related to the DBS, or to something else? Given
control over one’s own implants, might it become possible to become
somewhat lost, chasing some idealised emotional state, unsure if what one was
feeling in the present was genuine? There is an overlap here with possible
interpretations people might make with medications. However, people have
more control over their medications: they can often choose to stop taking them,
and if they do, there is no hardware to surgically remove.

According to the National
Institute of Mental Health DBS carries risks associated with any type of
brain surgery. For example, the procedure may lead a number of unwanted effects including: bleeding
in the brain or stroke, infection, disorientation
or confusion, mood changes, movement
disorders, light-headedness and trouble
sleeping.

Because the procedure is
still experimental, other side effects that are not yet identified may be
possible. Long-term benefits and side effects are unknown. Perhaps it’s
therefore unsurprising that, regarding DBS, OCD-UK states:

‘OCD-UK
do not recommend DBS as a treatment for OCD and remain concerned that the
dangers associated with the procedure continue to be overlooked by the medical
community when much safer and less invasive treatments remain available.’

If DBS for distress is
found to be effective, and safety concerns can be addressed, who will decide
who receives surgery? Will people experiencing the conditions decide? Will the
state decide? Are we at risk of re-treading the path forged by Walter
Freeman II, inventor and prolific practitioner of the ‘ice pick’
lobotomy, who seemed to genuinely believe that his intervention was a panacea
for mental health issues? He seemed
pretty confidentabout the emotional
state people should be in. There may also be there parallels with the continued
administration of electroconvulsive therapy, whose evidence is tenuous at
best. I also wonder if, as well as novelty, we also value treatments which
are dramatic. Part of a primal urge to
physically destroy the source of our suffering, as suggested by prehistoric
remains found with injuries indicative of trepannings?

So when we are presented
with miraculous-sounding cures, perhaps we need to exercise healthy scepticism
and, whilst not automatically dismissing them, ask some relatively
straightforward questions:

On
which evidence shall our decisions be based?

In
whose interests was that evidence collected and presented?

Who
stands to benefit from the treatment? This extends beyond potential recipients
to the companies producing them, and the reputations of the people associated
with them.

And
last but never least, do the potential benefits outweigh the
risks?

This is highly lucrative (renting or buying a hyperbaric chamber is costly), and people continue to pay large sums to put their child in a hyperbaric chamber, despite no decent evidence of benefit and clear guidance from NICE, advising against their use. There's also, as you say, an ethical dilemma here, as attempting to "cure" autism means making judgements about normality and abnormality.

I had not heard of pressure chamber treatments for autism. Interesting that the article talks of "healing" processes being activated by the pressurised oxygen, as if autism is some sort of wound or illness to be recovered from. One wonders whether some people might subjectively find the experience pleasant, not unlike Temple Grandin's Hug Machine. This might account for some positive reports from the intervention.

Placebo research also suggests that the more intrusive and uncomfortable an intervention is, the more effective it tends to be. This sounds very intrusive, and both physically and financially uncomfortable. They describe someone who referred to their study as a placebo or sham as "amoral", which is intriguing. There are two pictures of brains included, which adds to the seductive allure of the piece, although recently there has been critique of " the seductive allure of seductive allure " -

http://m.pps.sagepub.com/content/8/1/88.abstract

It seems that sometimes people really want to change certain states or conditions, and they can be driven to extreme treatments depending on their desperation. Perhaps the more drastic the treatment, the more faith it can engender in people when they are desperate.

About the Salomons Centre

The Salomons Centre for Applied Psychology in Tunbridge Wells, England. We are part of the Canterbury Christ church University Department of Psychology, Politics and Sociology. We run training courses in Clinical Psychology and CBT and also practice improvement programmes for child and adolescent mental health services. On this site staff and trainees in the Department write about a wide range of issues related to applied psychology, psychological therapies, policy and health service development.